AB1563-HPR TRAINING AND ASSESSMENT OF MUSCULOSKELETAL ULTRASOUND AND INJECTION SKILLS - A SYSTEMATIC REVIEW
Authors: S. M. D. Carstensen, M. Velander, L. Konge, M. Østergaard, M. Pfeiffer-Jensen, S. A. Just, L. Terslev
Journal: Annals of the Rheumatic Diseases (2022)

Background The importance of international harmonization regarding education of rheumatologists in musculoskeletal ultrasound (MSUS) and injection skills have been highlighted in several studies, including the need for standardized training programs containing competency-based education using validated assessment tools [1-2]. Objectives To examine how residents are trained and assessed in MSUS, MSUS-guided and landmark-guided joint aspiration and injection. Additionally, to present the available assessment tools and examine their supporting validity evidence. Methods A systematic search of PubMed, Cochrane Library, and Embase was conducted in accordance with the PRISMA guidelines and studies published from January 1, 2000 to May 31, 2021 were included. Two independent reviewers performed the search and data extraction. The studies were evaluated using the Medical Education Research Quality Instrument (MERSQI). Results 9,884 articles were screened and 43 were included; 3 randomized studies, 21 pre- and post-test studies, 16 descriptive studies (Table 1), and 3 studies developing assessment tools. The studies used various theoretical training modalities e.g. lectures, anatomical quizzes, and e-learning. The practical training models varied from mannequins and cadavers to healthy volunteers and patients. Most studies used subjective “comfort level” as assessment, others used practical examination and/or theoretical examination. All training programs increased trainees’ self-confidence, theoretical knowledge, and/or practical performance, however few used validated assessment tools to measure the effect. Only one study met the MERSQI high methodical quality cut-off score of 14. Table 1. Description of included studies examining training of MSUS, MSUS-guided or landmark-guided joint aspiration and injection skills. Study characteristics MSUS MSUS-guided Landmark-guided No. of studies a 14 3 23 Study design 0 0 3 Randomized 2 2 17 Pre- and post-test 12 1 3 Descriptive Participants b 408 38 1388 Residents 1 - 8 Experts 149 Medical students 47 Others Assessment c 7 1 - Objective - - 2 Practical 2 1 13 Theoretical 5 1 8 Subjective Questionnaire Mixed MERSQI d 9.2 7.5 8.9 Mean score Legend: a Studies developing assessment tools are not included in this table. b Accumulated number of participants enrolled in the studies. c Number of studies. d Mean score using the Medical Education Research Study Quality Instrument, maximum score =18. Conclusion The included studies were heterogeneous, and most were of poor methodological quality and not based on contemporary educational theories. This review highlights the need for educational studies using validated theoretical and practical assessment tools to ensure optimal MSUS training and assessment in rheumatology. References [1]Naredo E, D’Agostino MA, Conaghan PG, Backhaus M, Balint P, Bruyn GAW, et al. Current state of musculoskeletal ultrasound training and implementation in Europe: Results of a survey of experts and scientific societies. Rheumatology 2010;49:2438–43. [2]Mandl P, Naredo E, Conaghan PG, D’Agostino M-A, Wakefield RJ, Bachta A, et al. Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies. Rheumatology 2012;51:184–90. Acknowledgements We thank Tove Margit Svendsen, research librarian at the Medical library at Rigshospitalet Denmark, for her assistance with developing the search string for the systematic review. Disclosure of Interests None declared